Healthcare Provider Details

I. General information

NPI: 1003299157
Provider Name (Legal Business Name): KAMOLLUCK TRATENG L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16999 MCGILL RD
SARATOGA CA
95070-9602
US

IV. Provider business mailing address

16999 MCGILL RD
SARATOGA CA
95070-9602
US

V. Phone/Fax

Practice location:
  • Phone: 541-250-2012
  • Fax:
Mailing address:
  • Phone: 541-250-2012
  • Fax: 408-413-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 16450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: